Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2012 -00179
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/30/2012
Parcel: 1 S136CB03700
Jurisdiction: Tigard
Site address: 11085 SW 83RD AVE
Project: CHABALA Subdivision: VILLAGE AT ORENCO Lot: 9
Project Description: Panel replacement and (1) branch circuit.
Contractor: EAGLE ELECTRIC LLC Owner: CHABALA, DOUG
PO BOX 931 11085 SW 83RD AVE
ST HELENS, OR 97051 TIGARD, OR 97223
PHONE: 503 - 397 -9017 PHONE:
FAX: 503 - 366 -4252
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 03/30/2012 $100.70
Specifics: amps or less
1 crt Branch Circuits w /Purchase 03/30/2012 $7.42
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 03/30/2012 $12.97
Electrical
Type of Const:
Occupancy Grp:
Total $121.09
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -0010 through OAR 952- 001 -0090. You may obtain - • _ les or E - t questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
gIF
Issued By: _ _� _ _ ermittee Signature:
• ' NER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for the next available Inspection date.
This permit card shall be kept In a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each Inspection.
03/29/2012 10:37 5033664252 EAGLE ELECTRIC PAGE 02/02
Electrical Permit Appl ;6 - i v r�►l( (►rrl(1 7 t 5r.O\I.1
City of Tigard Received
III Date/8 : i�j�) Permit No.: • _ , ,A,
• 13125 SW Hall Blvd. Tigard, OR 97223 Plan Rcvicw
/ Phone: 503.718.2439 Fax: 503.59 2 9 2012 Date/By: Other Permit:
TiCAan
Inspection Line: 503.639.4175 Date Ready/By: rwia. fa See Page 2 for
lntemet: www.tigerd -e r.gov Notifed/Method: j Suppteeeetal lnformadon
CITY OF TIGARD
TYPE sof ifyOt3Xt�, Division PLAN REVIEW .
❑ New construction Addition /alterntti e een Please check all that apply (submit 2 sets of plans w /items checked below):
ID Demolition ID Other: ❑ Service or feeder 400 amps or more ❑ Building over three stories.
where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
® 1 and 2 family dwelling ID Commercial/industrial ❑ Accessory building teas to ground.
of a exceeds t ns. ❑ Commtxial use agricultural
rY g � amps far all other installations. buildings,
❑ Multi - family El Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION
El Emergency system. larger separately derived system. El Addition of new motor load of ID "A ", "E". "1.2 ", "1 - ",
Job no.: 12 - 444 - 1 I Job site address: 11085 SW 83rd 1001W or more occupancy.
o Six or more residential units. ❑ Recreational vehicle parks.
City /State/ZIP: Tigard, OR 97223 ❑ Health-care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: I Project name: Doug Chabala O Service or feeder 600 amps or more.
Cross street/directions to job site: FEE SCHEDULE
i
� DaerioGoa I Orr. I Pee. I Tarot I"
. New residential single- or muld•thmfly dwelling unit.
includes attached garage. _
Subdivision: I Lot no.: 1,000 sq. ft. or less 168.54 4
Tax map /parcel no.: Ea. add'I 500 sq. ft. or portion 33.92 1
Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
•
panel change and add one circuit Limited residen (with ft.) 75 2
Services or feeders Installation, alteration, and/or relocation
200 amps or less 1 100.70 100.70 2
In PROPERTY OWNER I ❑TENANT 201 amps to 400 amps 133.56 _ 2
Name: 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps.or volts 552.26 2
City /State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 1 2
Owner installation: This installation is being made on property that I own which is not aol amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits— new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, I 7.42 7.42 2
each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: branch circuit
Each add branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
City/State /ZIP: Each manufactured or modular 67.84 2
dwelling, service and/or feeder
Phone: ( ) I Fax: : ( ) Reconnect only 67.84 2
E - mail: Pump or irrigation circle 67.84 2
CONTRACTOR Signor outline lighting + 67.84 2
Signal circuit(s) or limited-energy
Business name: Eag;e Electric LLC panel. alteration, or extension. _ Page 2 2
.... Each addtdonal inspection over allowable in any of the abov
Address: POD 931 Additional inspection (I hr min) 66.25/ hr
Investigation (I hr min) 66.25/ hr
City /State/ZIP: St Helens, OR 97051
industrial plant (I hr min) 78.18/ hr
Phone: (503) 397901
Tel /�� I F 503) 3664252 Inspections for which no fee is hr
$ /a� specifically listed (t4 hr min)
CCB Lie.: 197277 Electrical Lie; .: • r Suprv. Lie.: 56775 ib hh ? ELECTRICAL PERMIT FEES
4S�. r Subtotal: 108.12
Suprv. Electrician signature, required: � � 6 -
f Plan review (25% of permit fee):
Print name: Daniel Pharr Date: 3/28/12 State surcharge (12% of permit fee): 12.91
Authorized signature:
TOTAL, PERMIT FEE: 121.09
L This permit application expires if a permit ;s not obtalaed within 180
• Print name: Date: • days after it has been accepted as complete.
Number of inspections allowed oar permit.
l: 1Duilding \PennitatELC•PermitApp.doc 07101/10 440.4615T(11/05/COM/WE8